1. Technical Field
The disclosure relates to a surgical apparatus and method and more particularly to a surgical apparatus and method for retracting tissue and/or bone.
2. Background of the Related Art
The diagnosis and treatment of coronary disease and related conditions typically require access to the heart, blood vessels, and associated tissue. Such procedures include cardiopulmonary bypass, valve repair and replacement, and treatment of aneurysms. Until recently, access to the patient's thoracic cavity was achieved by a large longitudinal incision in the chest. This procedure, referred to as a median sternotomy, required a saw or other cutting instrument to cut the sternum and allow two opposing halves of the rib cage to be spread apart. U.S. Pat. No. 5,025,779 to Bugge discloses a retractor which is designed to grip opposite sternum halves and spread the thoracic cavity apart. The large opening which is created by this technique enables the surgeon to directly visualize the surgical site and perform procedures on the affected organs. However, such procedures that involve large incisions and substantial displacement of the rib cage are often traumatic to the patient with significant attendant risks. The recovery period may be extended and is often painful. Furthermore, patients for whom coronary surgery is indicated may need to forego such surgery due to the risks involved with gaining access to the heart.
To avoid the risks and pitfalls of median sternotomies, a minimally invasive "window" approach to vascular or cardiac surgery has been developed. One example of the window approach is disclosed in European patent application 97106912.5, filed Apr. 25, 1997. The 97106912.5 application shows a ring shaped retractor having a series of retractor blades mounted thereon to spread the ribs and allow access to the heart for performing procedures such as coronary bypass.
In certain instances, additional access to other vessels and improved visibility is desirable. One way to achieve this would be to not only spread the retractor blades apart to spread the ribs laterally, but to also spread the ribs and surrounding upwardly away from the body, e.g. to lift the tissue. This would enable additional procedures to be performed through a window approach, such as an "IMA (internal mammary artery) takedown" where the artery is dissected for subsequent attachment to the heart or other vessel to complete the bypass. Furthermore, an apparatus and procedure are needed which provide a stable framework for supporting additional instruments which may be used during these procedures, while still providing the appropriate access.